Kim Hyunjee, Norton Edward C
Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR.
Department of Health Policy and Management and Department of Economics, University of Michigan, NBER, Ann Arbor, MI.
Health Serv Res. 2015 Oct;50(5):1606-27. doi: 10.1111/1475-6773.12290. Epub 2015 Mar 2.
To estimate the effect of the 10 percent cap introduced to Medicare home health care on treatment intensity and patient discharge status.
Medicare Denominator, Medicare Home Health Claims, and Medicare Provider of Services Files from 2008 through 2010.
We used agency-level variation in the proportion of outlier payments prior to the implementation of the 10 percent cap to identify how home health agencies adjusted the number of home health visits and patient discharge status under the new law.
Under the 10 percent cap, agencies dramatically decreased the number of service visits. Agencies also dropped relatively healthy patients and sent sicker patients to nursing homes.
The drastic reduction in the number of service visits and discontinuation of relatively healthy patients from home health care suggest that the 10 percent cap improved the efficiency of home health services as intended. However, the 10 percent cap increased other types of health care expenditures by pushing sicker patients to use more expensive health services.
评估医疗保险家庭医疗保健引入的10%上限对治疗强度和患者出院状态的影响。
2008年至2010年的医疗保险分母、医疗保险家庭医疗索赔和医疗保险服务提供者文件。
我们利用10%上限实施前异常支付比例的机构层面差异，来确定家庭医疗保健机构如何根据新法律调整家庭医疗访问次数和患者出院状态。
在10%上限政策下，机构大幅减少了服务访问次数。机构还放弃了相对健康的患者，并将病情较重的患者送往疗养院。
服务访问次数的大幅减少以及相对健康的患者不再接受家庭医疗保健，这表明10%上限按预期提高了家庭医疗服务的效率。然而，10%上限通过将病情较重的患者推向使用更昂贵的医疗服务，增加了其他类型的医疗保健支出。
